eMedicine Specialties > Emergency Medicine > Ophthalmology

Retinal Artery Occlusion: Follow-up

Author: Neil Jain, MD, Staff Physician, Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine
Coauthor(s): Pascal SC Juang, MD, FAAEM, FACEP, Medical Director, ED Information Systems, Attending Physician, Department of Emergency Medicine, Hoag Memorial Hospital Presbyterian
Contributor Information and Disclosures

Updated: Jun 30, 2009

Follow-up

Further Inpatient Care

  • Further inpatient care is indicated only if comorbid disease is present.

Further Outpatient Care

  • Patients should have serial evaluation of visual acuity by an ophthalmologist.
  • An ophthalmologist should perform evaluation for subsequent neovascularization of the iris or retina.
  • If HBO is to be used, several treatments may be necessary.
  • Patients require urgent follow up for carotid and cardiac evaluation to preclude further central retinal artery occlusion (CRAO) or stroke.

Inpatient & Outpatient Medications

  • Inpatient or outpatient medications are indicated only if comorbid disease is present.

Transfer

  • Transfer to a hyperbaric facility is necessary if hyperbaric oxygen is to be administered.

Deterrence/Prevention

  • Patients should keep their blood pressure under control, lower their cholesterol, avoid IV drugs, and take their medication.

Complications

  • Further emboli to brain resulting in CVA
  • Further emboli to the same or contralateral eye, resulting in further visual loss
  • Progression of temporal arteritis, resulting in loss of vision to the contralateral eye

Prognosis

  • Recovery of useful vision is related directly to the rapidity of treatment and presenting visual acuity.
  • Studies report that 21% of patients exhibited visual improvement of 6 gradients of visual acuity, 35% exhibited improvement of 3 gradients of visual acuity, while 26% showed no improvement in visual acuity.
  • Patients that showed improvement had presenting visual acuity of counting fingers and a mean duration of visual loss of 21.1 hours; those that did not improve had presenting visual acuity of hand movement and a mean duration of visual loss of 58.6 hours.
  • The longest delay to treatment that has been associated with significant visual recovery is approximately 72 hours.
  • Presence of a cilioretinal artery with foveolar sparing increases improvement of visual acuity.
  • Branch retinal artery occlusions (BRAOs) are associated with a higher recovery rate (80% of eyes improve to 20/40 or better) than central retinal artery occlusions (CRAOs).

Patient Education

  • Patients must understand that the prognosis for visual recovery is poor and that the visual changes are usually a result of a systemic process that needs treatment.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform a workup for the systemic cause of CRAO, leading to a progression of disease or recurrence of symptoms
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Kilbourn Gordon III, MD, and Enoch Huang, MD, to the development and writing of this article.



More on Retinal Artery Occlusion

Overview: Retinal Artery Occlusion
Differential Diagnoses & Workup: Retinal Artery Occlusion
Treatment & Medication: Retinal Artery Occlusion
Follow-up: Retinal Artery Occlusion
Multimedia: Retinal Artery Occlusion
References
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References

  1. Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. Sep 2007;27(3):215-30. [Medline].

  2. Beiran I, Goldenberg I, Adir Y, Tamir A, Shupak A, Miller B. Early hyperbaric oxygen therapy for retinal artery occlusion. Eur J Ophthalmol. Oct-Dec 2001;11(4):345-50. [Medline].

  3. Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol. Nov 2008;146(5):700-6. [Medline].

  4. Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic central retinal artery occlusion. Ophthalmology. Dec 1995;102(12):2029-34; discussion 2034-5. [Medline].

  5. Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal artery obstruction. Br J Ophthalmol. Dec 1980;64(12):913-7. [Medline].

  6. Beiran I, Reissman P, Scharf J, et al. Hyperbaric oxygenation combined with nifedipine treatment for recent-onset retinal artery occlusion. Eur J Ophthalmol. Apr-Jun 1993;3(2):89-94. [Medline].

  7. Brown GC. Retinal artery obstructive disease. In: Ryan SJ, ed. Retina. Vol 2. St. Louis: Mosby; 1994:1361-77.

  8. Brown GC, Magargal LE, Shields JA, et al. Retinal arterial obstruction in children and young adults. Ophthalmology. Jan 1981;88(1):18-25. [Medline].

  9. Butz B, Strotzer M, Manke C, et al. Selective intraarterial fibrinolysis of acute central retinal artery occlusion. Acta Radiol. Nov 2003;44(6):680-4. [Medline].

  10. Cella W, Avila M. Optical coherence tomography as a means of evaluating acute ischaemic retinopathy in branch retinal artery occlusion. Acta Ophthalmol Scand. Nov 2007;85(7):799-801. [Medline].

  11. Ffytche TJ, Bulpitt CJ, Kohner EM, et al. Effect of changes in intraocular pressure on the retinal microcirculation. Br J Ophthalmol. May 1974;58(5):514-22. [Medline].

  12. Fraser S, Siriwardena D. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database Syst Rev. 2002;CD001989. [Medline].

  13. Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinal tolerance time. Ophthalmology. Jan 1980;87(1):75-8. [Medline].

  14. Hertzog LM, Meyer GW, Carson S, et al. Central retinal artery occlusion treated with hyperbaric oxygen. J Hyperbaric Med. 1992;7:33-42.

  15. Klein R, Klein BE, Moss SE, Meuer SM. Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study. Arch Ophthalmol. Oct 2003;121(10):1446-51. [Medline].

  16. Knoop K, Trott A. Ophthalmologic procedures in the emergency department--Part I: Immediate sight-saving procedures. Acad Emerg Med. Jul-Aug 1994;1(4):408-12. [Medline].

  17. Lacy C, Armstrong LL, Ingram N, et al. Drug Information Handbook. 4th ed. Hudson, Cleveland: Lexi-Comp Inc; 1996.

  18. Magargal LE, Goldberg RE. Anterior chamber paracentesis in the management of acute nonarteritic central retinal artery occlusion. Surg Forum. 1977;28:518-21. [Medline].

  19. Mangat HS. Retinal artery occlusion. Surv Ophthalmol. Sep-Oct 1995;40(2):145-56. [Medline].

  20. Mead GE, Lewis SC, Wardlaw JM, Dennis MS. Comparison of risk factors in patients with transient and prolonged eye and brain ischemic syndromes. Stroke. Oct 2002;33(10):2383-90. [Medline].

  21. Miyake Y, Horiguchi M, Matsuura M, et al. Hyperbaric oxygen therapy in 72 eyes with retinal arterial occlusion. 9th International Symposium on Underwater and Hyperbaric Physiology. 1987;949-53.

  22. Rumelt S, Brown GC. Update on treatment of retinal arterial occlusions. Curr Opin Ophthalmol. Jun 2003;14(3):139-41. [Medline].

  23. Schmidt D, Schumacher M, Wakhloo AK. Microcatheter urokinase infusion in central retinal artery occlusion. Am J Ophthalmol. Apr 15 1992;113(4):429-34. [Medline].

  24. Schmidt DP, Schulte-Monting J, Schumacher M. Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. AJNR Am J Neuroradiol. Sep 2002;23(8):1301-7. [Medline].

  25. Suri MF, Nasar A, Hussein HM, Divani AA, Qureshi AI. Intra-arterial thrombolysis for central retinal artery occlusion in United States: Nationwide In-patient Survey 2001-2003. J Neuroimaging. Oct 2007;17(4):339-43. [Medline].

  26. Wray SH. The management of acute visual failure. J Neurol Neurosurg Psychiatry. Mar 1993;56(3):234-40. [Medline].

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Further Reading

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Keywords

retinal artery occlusion, RAO, branch retinal artery occlusion, BRAO, central retinal artery occlusion, CRAO, retinal disease, arterial occlusive disease, ocular stroke, embolism of the retinal artery, retinal artery emboli, loss of vision

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Contributor Information and Disclosures

Author

Neil Jain, MD, Staff Physician, Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine
Neil Jain, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Pascal SC Juang, MD, FAAEM, FACEP, Medical Director, ED Information Systems, Attending Physician, Department of Emergency Medicine, Hoag Memorial Hospital Presbyterian
Pascal SC Juang, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance
Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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